19 (4) 2020 ISSN 1644-0757 Eissn 2450-047X

ISSN 1644-0757 eISSN 2450-047X

19 (4) 2020 ISSN 1644-0757 eISSN 2450-047X

ACTA SCIENTIARUM POLONORUM

Czasopismo naukowe zaáoĪone w 2001 roku przez polskie uczelnie rolnicze Scientific Journal established in 2001 by Polish Life Sciences Universities

Oeconomia

Economics

Ekonomia

19 (4) 2020

October – December

Bydgoszcz Kraków Lublin Olsztyn PoznaĔ Siedlce Szczecin Warszawa Wrocáaw Acta Scientiarum Polonorum Programming Board Józef Bieniek (Kraków), Barbara Gąsiorowska (Siedlce), Kazimierz Banasik (Warsaw), Janusz PrusiĔski (Bydgoszcz) – chairman, Julita Reguáa (PoznaĔ), Wiesáaw Skrzypczak (Szczecin), Jerzy Sobota (Wrocáaw), Krzysztof Szkucik (Lublin), Ryszard ħróbek (Olsztyn)

Oeconomia Scientific Board Marta Barna (Lviv University of Trade and Economics, Lviv, UA), Henrietta Nagy (Szent Istvan University, GödöllĘ, HU), Roman Kisiel (University of Warmia and Mazury, Olsztyn, PL), Joseph Andrew Kuzilwa (Mzumbe University, Morogoro, TZA), Luboš Smutka (Czech University of Life Sciences, Prague, CZ), Wiesáaw Musiaá (University of Agriculture in Krakow, Kraków, PL), Janina Sawicka (Warsaw University of Life Sciences – SGGW, Warsaw, PL) – chairperson, Harun Uçak (Alanya Alaaddin Keykubat University, Alanya, TR), Andra Zvirbule-BƝrziƼa (Latvia University of Agriculture, Jelgava, LV)

Editing committee Jan Kiryjow – Warsaw University of Life Sciences Press, Iwona Pomianek – Warsaw University of Life Sciences – SGGW, Warsaw – vice-chairperson, Marcin Chciaáowski – WULS-SGGW, Warsaw – Oeconomia secretary, Renata Marks-Bielska – University of Warmia and Mazury, Olsztyn – thematic editor, àukasz Satoáa – University of Agriculture in Krakow, Kraków – thematic editor, Anna Milewska – WULS-SGGW, Warsaw – thematic editor, Halina PowĊska – WULS-SGGW, Warsaw – thematic editor, Joanna Rakowska – WULS-SGGW, Warsaw – thematic editor, Paulina Stolarczyk – WULS-SGGW, Warsaw – thematic editor, Paulina TrĊbska – WULS-SGGW, Warsaw – thematic editor, Mariola Chrzanowska – WULS-SGGW, Warsaw – statistical editor, Jacqueline Lescott – Tranchant Consulting Group LLC – language consultant

The printed version of Acta Scientiarum Polonorum Oeconomia is an initial version of the journal

Editorial staff Anna Doáomisiewicz, ElĪbieta Wojnarowska

ISSN 1644-0757 eISSN 2450-047X

Warsaw University of Life Sciences Press, Nowoursynowska 166, 02-787 Warsaw tel. (22) 593 55 20 (-22; -25 – sales) e-mail: [email protected] www.wydawnictwosggw.pl

Print: ZAPOL sp.j., al. Piastów 42, 71-062 Szczecin From the Scientific Board There has been the nineteenth year of the Acta Scientiarum Polonorum Oeconomia publishing. The Acta is the periodical including several thematic series with uniform graphics and similar format. The publication was set up by group of enthusiasts – employees of life sciences universities and has been published under the patronage of rectors of these universities. Constant involvement of academic society in increasing substantive and editorial level of the series, with efforts of the authors, the Programming Board and the Scientific Boards, has contributed to placing the Acta Scientiarum Polonorum (and our Oeconomia series) on the noticeable position in academic research society. Articles can be prepared in English with Polish title, abstract and keywords. Moreover, we publish latest issues in English only. The Scientific Board of the Oeconomia series, concerning the publication range, focuses its attention both on substantive content and precision of the form. The articles are revised in “double-blind review” process. Whole content of the Acta Scientiarum Polonorum Oeconomia is available in electronic version on the following websites acta_oeconomia.sggw.pl and www.oeconomia.actapol. net. We are glad to inform that Acta Scientiarum Polonorum Oeconomia are indexed within the AGRIS-FAO, EB- SCO, SIGĩ, Copernicus Index, Central and Eastern European Online Library, AGRO, BazEkon, POL-index.

Please send papers using the publishing system via the link below: https://js.wne.sggw.pl

Yours sincerely Janina Sawicka Chairperson of the Scientific Board of the Acta Sci. Pol. Oeconomia series LIST OF REVIEWERS 2020

Kseniia Baimakova (Russia) Magdalena Mądra-Sawicka (Poland) Rafaá Balina (Poland) Aneta Mikuáa (Poland) Marta Barna (Ukraine) Anna Milewska (Poland) Aleh Bakhur (Belarus) Etleva Muça (Dashi) (Albania) Ewa Bąk-Filipek (Poland) Balázs Nagy (Hungary) Aneta Beádycka-Bórawska (Poland) Robert Nowacki (Poland) Joanna BereĪnicka (Poland) Dan Ophir (Israel) Wioletta BieĔkowska-Goáasa (Poland) Mykola Orlykovskyi (Poland) Krzysztof BáoĔski (Poland) Irena Ozimek (Poland) Abdulmajid Bobokhonov (Spain) Joanna Paliszkiewicz (Poland) Katarzyna BoratyĔska (Poland) Johana Paluchová (Slovakia) Anila Boshnjaku (Albania) Maria ParliĔska (Poland) Piotr Bórawski (Poland) Agnieszka ParliĔska (Poland) Mirosáawa Braja (Poland) Tomasz Pawlonka (Poland) Horst Brezinski (Germany) Mariya Peneva (Bulgaria) Katarzyna BrodziĔska (Poland) Józef Jan Pfaff (Poland) Heorhii Cherevko (Ukraine) Anna Piotrowska (Poland) Mariola Chrzanowska (Poland) Jose Ramos Pires (Portugal) Piotr Cyrek (Poland) Iwona Pomianek (Poland) Katarzyna Czech (Poland) Mufutau Popoola (Nigeria) Marta Czekaj (Poland) Halina PowĊska (Poland) Nadiia Davydenko (Ukraine) Bogusáaw Pytlik (Poland) Nina Drejerska (Poland) Ewelina Rabiej (Poland) Bogdan DróĪdĪ (Poland) Maágorzata Raczkowska (Poland) Baseer Durrani (United Kingdom) Razaq Raj (United Kingdom) Justyna Franc-Dąbrowska (Poland) Joanna Rakowska (Poland) Barbara Freytag-Leyer (Germany) Tomasz Rokicki (Poland) Agnieszka Gehringer (Germany) Michaá Roman (Poland) Monika GĊbska (Poland) Rasa Rukuiziene (Lithuania) àukasz GĊbski (Poland) Vitaliy Rybchak (Ukraine) Piotr Goáasa (Poland) Roman Sass (Poland) Emilia GosiĔska (Poland) àukasz Satoáa (Poland) Aleksandra Górecka (Poland) Tamara Selisheva (Russia) Hanna Górska-Warsewicz (Poland) Aldona SkarĪyĔska (Poland) Kinga Gruziel (Poland) Stefan SmoczyĔski (Poland) Mariusz Hamulczuk (Poland) Luboš Smutka (Czech Republic) Juris Hazners (Latvia) Wioleta Sobczak (Poland) Marcin Idzik (Poland) Grzegorz Sobiecki (Poland) Mikoáaj Jalinik (Poland) Christoph Sowada (Poland) Anna Jasiulewicz (Poland) Ewa Stawicka (Poland) Jacek Jaworski (Poland) Paulina Stolarczyk (Poland) Marzena Kacprzak (Poland) Dariusz StrzĊbicki (Poland) Sáawomir Kalinowski (Poland) Joanna Szwacka-Mokrzycka (Poland) Ana Kapaj (Albania) Josu Takala (Finland) Ryszard Kata (Poland) Vojtech Tamas (Czech Republic) Oksana Kiforenko (Ukraine) Ágnes Treutz (Hungary) Marina Klaþmer ýalopa (Croatia) Paulina TrĊbska (Poland) Anna Káoczko-Gajewska (Poland) Jonathan Tuthil (USA) Volodymyr Kolodiichuka (Ukraine) Harun Ucak (Turkey) Stanislava Kontsevaya (Russia) Magdalena Ulrichs (Poland) Pavel Kotyza (Czech Republic) Monika Utzig (Poland) Andrzej Kowalski (Poland) Mirosáaw Wasilewski (Poland) Sylwester Kozak (Poland) Agnieszka Werenowska (Poland) Barbara Kutkowska (Poland) Izabela Wielewska (Poland) Susanna O. Kytaieva (Ukraine) Marek Wigier (Poland) Joanna Landmesser (Poland) Agnieszka Wojewódzka-Wiewiórska (Poland) Marzena Lemanowicz (Poland) Barbara Wyrzykowska (Poland) Radim Lenort (Poland) Srdan Vujicic (Croatia) Natalija Lepkova (Lithuania) Simonida Vukadinovic (Serbia) Wojciech Lichota (Poland) Tomasz Zalega (Poland) Manuela Meçe (Albania) Oksana Zamora (Ukraine) Ktut Silvanita Mangani (Indonesia) Jan Zawadka (Poland) Uliana Marchuk (Ukraine) Aldona Zawojska (Poland) Renata Marks-Bielska (Poland) Magdalena Zioáo (Poland) Mariusz Matyka (Poland) Dorota ĩebrowska-Suchodolska (Poland) Ludwik Mazurkiewicz (Poland) Jan Žukovskis (Lithuania) CONTENTS SPIS TREŚCI

Justyna Barczyk-Ciuáa, àukasz Satoáa Urban sprawl entrepreneurship as an alternative to decentralization of the labor market: case study on the Kraków Metropolitan Area ...... 5 PrzedsiĊbiorczoĞü urban sprawl jako alternatywa decentralizacji rynku pracy na przykáadzie Krakowskiego Obszaru Metropolitalnego

Olga Bodnar, Julia Galchynska, Mariusz Maciejczak Price interdependence of agricultural commodities from Ukraine and world markets ...... 15 WspóázaleĪnoĞci cenowe towarów rolnych z Ukrainy i rynku Ğwiatowego

Andrzej Buszko Labour market flexibility in the context of the shadow economy for the construction industry ...... 23 ElastycznoĞü rynku pracy w kontekĞcie szarej strefy

Marzena Ganc Working capital management strategy and selected measures of financial security for dairy cooperatives in Poland ...... 33 Strategia zarządzania kapitaáem obrotowym a wybrane mierniki bezpieczeĔstwa finansowego spóádzielni mleczarskich

Kinga Gruziel Stability of leadership as a determinant in the development of budgetary units in Poland ...... 41 StabilnoĞü wáadzy jako determinant rozwoju jednostek budĪetowych

Wojciech Grzegorczyk Links between the creating shared value concept and a company’s marketing strategy ...... 51 Relacje miĊdzy koncepcją creating shared value a strategią marketingową przedsiĊbiorstwa

Magdalena Jarczok-Guzy Impact of tax instruments on the organic food market in Poland ...... 59 Oddziaáywanie instrumentów podatkowych na rynek ĪywnoĞci ekologicznej w Polsce

Sáawomir Kalinowski Poverty in rural areas: an outline of the problem ...... 69 Ubóstwo na wsi. Zarys problemu

Posma Sariguna Johnson Kennedy Health policy problems in Indonesia’s border region ...... 79 Problemy polityki zdrowotnej w regionie granicznym Indonezji

Roman Kisiel, Aleksandra Kowalewska, Joanna Kowalewska Impact of implemented innovations on competitiveness of tourism companies in the WarmiĔsko-Mazurskie Voivodeship ...... 87 Wpáyw wdroĪonych innowacji na konkurencyjnoĞü przedsiĊbiorstw turystycznych w województwie warmiĔsko-mazurskim

Wojciech Lichota Use of discriminatory models to verify the likelihood of continued activities for enterprises: case study on select enterprises from the automotive industry ...... 95 Wykorzystanie modeli dyskryminacyjnych do weryfikacji prawdopodobieĔstwa kontynuacji dziaáalnoĞci przedsiĊbiorstw na przykáadzie próby przedsiĊbiorstw z branĪy motoryzacyjnej

Halina PowĊska The share of cross-border shopping in Poland’s trade turnover of food products with neighbouring countries on the European Union eastern border in 2013–2018 ...... 103 Udziaá handlu przygranicznego w obrotach handlowych artykuáami ĪywnoĞciowymi Polski z krajami sąsiadującymi na zewnĊtrznej granicy Unii Europejskiej w latach 2013–2018

Joanna Rakowska European Union funding for preservation of religious cultural heritage in Poland ...... 113 Fundusze Unii Europejskiej dla zachowania religijnego dziedzictwa kulturowego w Polsce

Eulalia SkawiĔska, Romuald Zalewski Impact of coronavirus COVID-19 on the food system ...... 121 Wpáyw koronawirusa COVID-19 na system ĪywnoĞciowy

Paulina Stolarczyk Self-generated economic activity as a form of employment for people with disabilities ...... 131 Wáasna dziaáalnoĞü gospodarcza jako forma zatrudnienia osób niepeánosprawnych

Monika ZieliĔska-Sitkiewicz The flu: an analysis of economic costs and morbidity rates in Poland in the period 2013–2019 using adaptive prediction methods ...... 139 Ekonomiczne koszty grypy i analiza zachorowalnoĞci na grypĊ w Polsce w latach 2013–2019 z wykorzystaniem adaptacyjnych metod predykcji INSTRUCTIONS TO AUTHORS

The journal Acta Scientiarum Polonorum Oeconomia features original scientific articles related to all aspects of economy, for example: food economy, European consumer goods market, sustainable regional development, development of culture environment, post crises political and social processes, human and social capital, labour market – gender perspective, public finances, rural development and entrepreneurship, social and innovative entrepreneurship, tourist economy. General and technical requirements for the elaboration of papers: 1. Size of the research paper including tables, figures and photographs should not exceed 12 pages of A-4 format. 2. Materials to be published in Acta Sci. Pol. should be prepared in accordance with the rules of the publishing process binding at the publishing office of a given series of the Journal. 3. Style of documents – the text of the paper should be typed with TNR font 12 points, 1 1/2 of space between the lines, setting parts of the text in special typeface is allowed, e.g. italic or bold, but without underlining letters, words and sentences. 4. Size of tables and figures cannot exceed B-5 format (12.5 × 19.5 cm); descriptions of tables should be typed with TNR font 9 points, content of tables 8 points, single space, if possible without vertical lines, table format – doc. or rtf. The following paper setting is binding: 1. Title of the article in Polish (or in English if the whole paper is in English; the same refers to the summary and key words). 2. First name and surname of the author (-s). 3. Afiliation. 4. Paper abstract (600–1000 characters). 5. Key words – up to 6 words useful when indexing and searching, from general to detail. 6. The main text of the research paper should include: introduction with the aim and research hypothesis, material and methods, results, discussion, conclusions (or summary) and references. 7. Title, abstract (600–1000 characters) as a translation of the summary and key words in English. 8. Address of the author’s (authors’) place of work – post and e-mail address. Titles of tables and their content, and captions of figures and legends must be provided in English, while the numbers of tables and figures – with Arabic numerals. Units and spelling – the international SI system is binding, e.g. gǜdm–3 (and not g/dm3). References – when referring to the publications of other authors in the text of the paper, a surname and a year should be provided in brackets [Kowalski and Lewandowski 2000, Lewandowski 2001, Zalewski et al. 2001] or …according to Kowalski [2000]... The list of references should be presented in the alphabetical order in the following way: author’s (authors’) surname, initials of first names; year of publishing if there is more than one paper of the same author published in a given year, after the year it is necessary to mark particular items a, b, c etc.; title of the paper, bibliographical abbreviation of the publishing house and place of publishing, numbers of volume, issue of periodic, book series, and pages, e.g.: Cheákowski, Z. (1966). Introdukcja troci do rzeki Gowienicy. (Introduction of brown trout into the Gowienica river). Gosp. Ryb., 1(2), 18–19. GreĔ, J., Kowalski, Z. (1972). Statystyka matematyczna. (Matematical statistics). PWN, Warszawa. Pisulewski, P., Strzetelski, J., Antoniewicz, A. (2009). Podstawowe zaáoĪenia IZ PIB-INRA norm Īywienia przeĪuwaczy (Basic objectives of nutritional standards for ruminants of the IZ PIB-INRA). [In:] J. Strzetelski (Ed.), IZ PIB-INRA. Normy Īywienia przeĪuwaczy. WartoĞü pokarmowa francuskich i krajowych pasz dla przeĪuwaczy. Wyd. IZ PIB, Kraków, 11–20. Patkowska, E., KonopiĔski, M. (2008a). Pathogenicity of selected soil-borne microorganisms for scorzonera seedlings (Scor- zonera hispanica L.). Folia Horticul., 20(1), 31–42. Patkowska, E., KonopiĔski, M. (2008b). Pathogenicity of selected soil-borne fungi for seedlings of root chicory (Cichorium intybus L. var. sativum Bisch.). Veg. Crops Res. Bull., 69, 81–92. Turski, W. (1972). Projektowanie oprogramowania systemów liczących. (Software design of computing systems). Mat. konf. Projektowanie maszyn i systemów cyfrowych. Warszawa 2–5 czerwca 1971. PWN, Warszawa, 132–139. The author sends the text of the paper in 2 copies to the editorial office. After he/she receives a review, the author sends an editorial copy to the editorial office including the reviewer’s comments, a corrected copy of the paper including an electronic carrier (diskette, CD or e-mail) and a response to the reviewer’s and editor’s comments. The main part of the publication (abstract, the text of the article proper and references) should be saved in one file. The editorial office reserves a right to make cuts and corrections, and to suggest changes and substantive supplementations agreed with the author. The graphic material (figures, diagrams, charts) should be prepared and sent as a separate electronic file (source files) made in programs working in Windows environment (e.g. in Excel, Corel Draw, Photoshop etc.). The author of the paper published is obliged to transfer his/her copyright to the publisher and submit a declaration that the paper has not been published in another journal. The authors of the papers participate in the costs of their publishing. Information about fees and additional information for authors are available at the websites: www.oeconomia.actapol.net www.acta_oeconomia.sggw.pl WSKAZÓWKI DLA AUTORÓW

Na áamach Acta Scientiarum Polonorum zamieszczane są oryginalne prace naukowe. Wszystkie prace są recenzowane przez specjalistów spoza jednostki macierzystej autorów z zachowaniem zasady wzajemnej anonimowoĞci, tzw. double-blind review process. Prace proponowane do druku w poszczególnych seriach naleĪy przesyáaü na adres odpowiednich wydawnictw uczelnia- nych lub na adresy ze stron internetowych poszczególnych serii. Wymogi ogólne i techniczne przygotowania prac: 1. ObjĊtoĞü pracy wraz z tabelami, rysunkami i fotografiami nie powinna przekraczaü 12 stron formatu A-4. 2. Materiaáy do publikacji w Acta Sci. Pol. powinny byü przygotowane zgodnie z zasadami procesu wydawniczego obowią- zującego w redakcji danej serii. 3. Styl dokumentów – tekst pracy naleĪy pisaü czcionką typu TNR 12 pkt, 1 1/2 odstĊpu miĊdzy wierszami, dopuszcza siĊ stosowanie wyróĪnieĔ w tekĞcie, np. kursywĊ i pogrubienie tekstu, ale bez podkreĞlania liter, wyrazów i zdaĔ. 4. WielkoĞü tabel i rysunków nie moĪe przekraczaü formatu B-5 (12,5 × 19,5 cm); rozszerzenie tabel – doc. lub rtf. Obowiązuje nastĊpujący ukáad pracy: 1. Tytuá artykuáu w jĊzyku polskim (lub angielskim, jeĪeli caáa praca jest w jĊzyku angielskim; to samo dotyczy streszczenia i sáów kluczowych). 2. ImiĊ i nazwisko autora (-ów). 3. Afiliacja wszystkich autorów. 4. Streszczenie strukturalne pracy (600–1000 znaków). 5. Sáowa kluczowe – do 6 sáów pomocnych przy indeksacji i wyszukiwaniu, ukáad (od ogólnych do szczegóáowych). 6. Tekst gáówny pracy naukowej powinien obejmowaü: wstĊp z celami i hipotezami badawczymi, materiaá i metody, wyniki, dyskusjĊ, wnioski (lub podsumowanie) i piĞmiennictwo. 7. Tytuá, abstract (600–1000 znaków) jako táumaczenie streszczenia i sáowa kluczowe w jĊzyku angielskim (lub polskim, jeĞli caáa praca jest w jĊzyku angielskim). 8. Adres do korespondencji – pocztowy i internetowy. Tytuáy tabel oraz ich treĞü, a takĪe podpisy rysunków i legendy muszą byü podane w jĊzyku polskim i angielskim, a numery tabel i rysunków – cyframi arabskimi. Jednostki i pisownia – obowiązuje miĊdzynarodowy ukáad SI, a jednostki powinny byü zapisane np: g·dm–3 (a nie g/dm3). PiĞmiennictwo – przy powoáywaniu siĊ w tekĞcie pracy na publikacje innych autorów podajemy w nawiasie nazwisko i rok, w ukáadzie chronologicznym [Kowalski i Lewandowski 2000, Lewandowski 2001, Zalewski i in. 2001] lub ...zdaniem Kowalskiego [2000]. Wykaz piĞmiennictwa naleĪy zestawiü w porządku alfabetycznym. Gdy w danym roku jest wydanych wiĊcej prac tego samego autora, po roku naleĪy oznaczyü poszczególne pozycje a, b, c itd., np.: Cheákowski, Z. (1966). Introdukcja troci do rzeki Gowienicy. Gosp. Ryb., 1(2), 18–19. GreĔ, J., Kowalski, Z. (1972). Statystyka matematyczna. PWN, Warszawa. Pisulewski, P., Strzetelski, J., Antoniewicz, A. (2009). Podstawowe zaáoĪenia IZ PIB-INRA norm Īywienia przeĪuwaczy. [W:] J. Strzetelski (red.), IZ PIB-INRA. Normy Īywienia przeĪuwaczy. WartoĞü pokarmowa francuskich i krajowych pasz dla przeĪuwaczy. Wyd. IZ PIB, Kraków, 11–20. Patkowska, E., KonopiĔski, M. (2008a). Pathogenicity of selected soil-borne microorganisms for scorzonera seedlings (Scorzonera hispanica L.). Folia Horticul., 20(1), 31–42. Patkowska, E., KonopiĔski, M. (2008b). Pathogenicity of selected soil-borne fungi for seedlings of root chicory (Cichorium intybus L. var. sativum Bisch.). Veg. Crops Res. Bull., 69, 81–92. Turski, W. (1972). Projektowanie oprogramowania systemów liczących. Mat. konf. Projektowanie maszyn i systemów cyfrowych. Warszawa 2–5 czerwca 1971. PWN, Warszawa, 132–139. Autor przesyáa do redakcji tekst pracy w 2 egzemplarzach. Po otrzymaniu recenzji Autor przesyáa do redakcji egzemplarz redakcyjny z uwagami recenzenta, poprawiony egzemplarz pracy wraz z noĞnikiem elektronicznym (dyskietka, CD lub e-mail) i ustosunkowaniem siĊ do uwag recenzenta i redaktora. CzĊĞü gáówną publikacji (streszczenie, wáaĞciwy tekst artykuáu oraz piĞmiennictwo) naleĪy zapisaü w jednym pliku. Tabele, rysunki i inne zaáączniki winny byü wáączone do tego pliku i dodatkowo znaleĨü siĊ w oddzielnych plikach. Redakcja zastrzega sobie prawo dokonywania skrótów i poprawek, a takĪe proponowania zmian i uzupeánieĔ merytorycznych uzgodnionych z autorem. Materiaá graficzny (rysunki, schematy, wykresy) powinien byü opracowany i przysáany jako osobny zapis elektroniczny (pliki Ĩródáowe) w programach pracujących w Ğrodowisku Windows (np. w programach Excel, Corel Draw, Photoshop itp.). Autor publikowanej pracy zobowiązany jest przenieĞü swe prawa autorskie na wydawcĊ i záoĪyü oĞwiadczenie, Īe praca nie byáa publikowana w innym czasopiĞmie Autorzy prac partycypują w kosztach ich wydania. Informacja o opáatach i dodatkowe informacje dla autorów znajdują siĊ na stronach internetowych.

www.oeconomia.actapol.net www.acta_oeconomia.sggw.pl Acta Sci. Pol. Oeconomia 19 (4) 2020, 79–85 acta_oeconomia.sggw.pl ISSN 1644-0757 eISSN 2450-047X DOI: 10.22630/ASPE.2020.19.4.43

ORIGINAL PAPER Received: 25.02.2020 Accepted: 16.10.2020

HEALTH POLICY PROBLEMS IN INDONESIA’S BORDER REGION

Posma Sariguna Johnson Kennedy

Duta Wacana Christian University, Indonesia

ABSTRACT

This paper aims to study health policy problems in Indonesia’s border areas. It is especially focused on the case of health problems in Nusa Tenggara Timur Province. The research method used is a quantitative description approach. It is necessary to increase the development of health infrastructure and its supporters in border areas. It is also necessary to socialise and improve health insurance services from the government, as well as improve human resources in the health sector.

Key words: health policy, health problems, border area, Nusa Tenggara Timur JEL codes: I18, O11

INTRODUCTION 43/2016 concerning Minimum Service Standards and the Minister of Health Regulation 75/2014 on Commu- Health development is currently facing inequity and nity Health Centres. Essential health services require disparity, especially health services between regions promotive, preventive, screening, curative, and reha- and income groups in Indonesia. Access to primary bilitative services. They must be provided comprehen- health services is still limited, especially in the dis- sively and holistically to both community groups and advantaged, border, and island areas. Geographical individuals, and cannot be partial. constraints cause limited access to health services in Public issues arise in border areas because they are many areas. Quality of service is not optimal because remote, often in the form of islands, and have extreme many necessary health facilities do not meet service topography. Therefore, the role of infrastructure is readiness standards and lack health service standards. also a significant physical component for the border Essential health services are needed in order to regions. Systematic, consistent, and targeted infra- achieve the Sustainable Development Goals (SDGs) structure development will lead to an increase in the 2030 targets. The success of critical health services by welfare of border communities. The primary health is- prioritising promotive and preventive services will re- sue is the availability of health support services and duce the burden of further assistance. Essential health facilities, which are still low because the distribution services consist of several types of health services that is uneven, only concentrated in big cities [Suharmiati are considered necessary for maintaining the health of et al. 2013]. a person, family, and community to live productively This study aims to assess the problems of health socially and economically. policy in the border area. Specifically, as an exam- In Indonesia, two provisions specify the types of ple case, the health and nutrition problems in Nusa essential services: the Minister of Health Regulation Tenggara Timur Province. The research method uses

Posma Sariguna Johnson Kennedy https://orcid.org/0000-0002-8146-3773 [email protected]

a quantitative description approach. The research- the vital role of primary health services, which must er uses various literature reviews and several data be supported by political commitments to strengthen sources as secondary data. the central health care system [Li et al. 2017]. Essen- tial health services are an effective way to: (1) reduce BASIC HEALTH SERVICES social disparities and exclusions in health matters; (2) improve equity; (3) meet the needs and expectations of The spatial inequality of the social development pro- the people; (4) minimise poverty; (5) integrate health cess in marginalised areas is mostly rural. Peripher- with other sectors; (6) encourage leadership that pro- als are complex and multidimensional concepts with motes cooperation and dialogue; (7) increase the ef- properties such as backwardness, dependence, mar- fectiveness of the health budget; (8) increase account- ginalisation, and appropriation. Weak regions and ability of health service facilities; and (9) increase the boundaries, whose relations and interconnections lead responsibility of state administrators [WHO 2012]. to permanent exclusion and marginalisation, find it To overcome the unequal health status and access difficult to break away from “dependence”, without to health services in the world, the World Health Or- outside interference. On the other hand, it must be ex- ganization (WHO) in the Alma Ata Declaration of 1978 plained that spatial inequality is a feature of socio-eco- recommended two strategies, namely: (1) to approach nomic development and is an inevitable phenomenon Primary Health Care; and (2) to formulate a National [Magnusson and Ottosson 2009]. High costs are a bar- Health System. In the declaration, Primary Health rier to the transfer of quality human resources to the Care is translated as several “essential health services suburbs. In financial investment and worker training, that are scientifically accountable, socially acceptable, prices are not enough to absorb innovation to improve accessible to every individual/family, organised with the economy and society in border areas, including in the participation of the community, economically can essential health services [Klimczuk and Klimczuk- be borne by the town and country, accompanied by -KochaĔska 2015]. a spirit of independence (self-reliance and self-deter- Basic health services are first-level health services mination)”. Primary Health Care is the first level of and are the first contact of the population with the the individual, family, and community contact with health service system, including promotive and pre- the national health system to bring health services as ventive activities, health assessments, diagnosis and close as possible to the residence and workplace. treatment for acute and chronic conditions, and reha- In the Alma Ata Declaration [WHO 1978] there bilitation services (Ontario Health Services Restruc- are five basic principles for the fulfilment of primary turing Commission, Primary Health Care Strategy). health services, including: (1) equitable distribution Basic health services are defined as a set of first-level of health efforts; (2) emphasis on preventive efforts; services that are universally accessible that promote (3) the use of appropriate technology in health efforts; health, prevent disease, and provide diagnostic, cura- (4) community participation in the spirit of independ- tive, rehabilitative, supportive, and palliative serv- ence, and (5) cross-sectoral cooperation in develop- ices. Basic health services refer to approaches to the ing health. In addition, the four pillars of basic health spectrum of services outside the traditional health ser- service reform that have been initiated by the WHO vice system, covering all functions that play a role in [2008] consist of: health, income, housing, education, and the environ- í Health financing reform. Government funding is ment [Muldoon et al. 2006]. directed more at public health efforts and health Some countries recognise the vital role of essen- services for the poor. tial health services to improve public health status and í Health policy reform. Health policy must be evi- have made efforts to reform critical health services. dence-based. In Turkey, health reform began in 2003 and brought í Health leadership reform. Health leadership must significant changes in primary health care [Cevik et al. be inclusive, participatory, and able to move across 2017]. The China National Roadmap 2030 emphasised sectors through advocacy competencies.

80 acta_oeconomia.sggw.pl Kennedy, P.S.J. (2020). Health policy problems in Indonesia’s border region. Acta Sci. Pol. Oeconomia 19 (4), 79–85, DOI: 10.22630/ ASPE.2020.19.4.43

í Health service reform. Basic health services must health workers’ distribution must be optimised, espe- develop a robust system in the context of the Com- cially in remote areas [Suharmiati 2013]. munity Health Centres with its network and with Primary health services in Indonesia’s border re- its supra system (district/city health office, and dis- gions are still low. Community Health Centre (Puskes- trict/city hospital). mas), the primary function of the mainstay of service for the community, has not been able to provide maxi- BORDER HEALTH ISSUES mum facilities for remote areas, especially in border areas. Due to the large working area of the Puskes- The border area should be the State Storefront or the mas, geographically, it is partly challenging to reach, forefront of the territory of the Republic of Indonesia, the population is small, scattered in small groups that which should look good because it is located on the are far apart. Means of transportation are also mini- front. But so far, there has been a disparity in the bor- mal with expensive costs, land, river, sea, and air. One der regions with neighbouring countries. They still reason is because of severe geographical conditions have difficulty accessing basic needs, such as educa- and climate/weather that often changes. The status tion, health, nutritional adequacy, and employment. of public health and coverage of health services in Their condition is deplorable, not so with neigh- remote border areas is still low. Society, in general, bouring countries. Therefore, the border area must does not yet have the knowledge and behaviour of become a standard interface space where the border healthy living and unfavourable environmental condi- community’s cosmopolitanism is seen as the power tions. Puskesmas services in remote border areas are to build a prosperous Homeland front page [Kennedy affected, among other issues, by the affordability of 2018]. services. Remote areas, borders and islands, have extreme Access to health services is not only caused by topography. Besides, geographical conditions are still distance problems, but there are two determinants, isolated due to limited road infrastructure, land trans- namely, the supply and demand factors. Determinants portation, rivers, and other public facilities. This con- of supply consist of service organisations and physi- dition impacts the health of social welfare, economy, cal infrastructure, place of service, availability, utilisa- education, and skills of border communities that are tion, distribution of officers, service costs, and service still lagging. Therefore the border area must be a top quality. The determinants of demand, which are user priority for infrastructure development. There is a sig- factors, include the low education and socio-cultural nificant correlation between the condition of infra- conditions of the community and the weak or inad- structure with the pulse of community socio-economic equate level of community income. The primary need activities and the welfare of the people on the border. for sufficient access to services is the availability of Infrastructure development will lead to an increase in facilities and staff, distance, and financially affordable the health of border communities [Shanteukie Word- and socio-cultural issues that users can accept [Tim- Press 2011]. yan 1997]. The availability of health services and supporting The availability of frequently changing assignment facilities in the disadvantaged areas, the border, and doctors in border areas also affects the management of islands is still low. The available resources and the the Puskesmas. Doctors with a contract period of one number of health workers needed in the field of pro- year, were too short to manage the Puskesmas prop- motive, preventive, curative, and rehabilitative efforts erly because, within that period, they had not mastered are always mostly concentrated in big cities. Even the Puskesmas program yet. Besides, doctors need to though the number of health workers is sufficient, their adapt to the environment, and it takes time for people to distribution is not evenly distributed. Optimisation of get to know them. Health centre resources, espe cially health workers is one effort to improve the availability, in remote border areas, still need to be improved, espe- equity, and quality of health workers, especially in re- cially regarding the balance of work tenure, workload, mote, disadvantaged, border, and island areas. Local and rewards for health workers.

acta_oeconomia.sggw.pl 81 Kennedy, P.S.J. (2020). Health policy problems in Indonesia’s border region. Acta Sci. Pol. Oeconomia 19 (4), 79–85, DOI: 10.22630/ ASPE.2020.19.4.43

The low number of patients visiting the Puskes- epidemiology in the Puskesmas area. The epidemiol- mas shows that the main Puskesmas is challenging to ogy of condition is essential in setting priorities and reach by the community, due to geographical location, target populations. By studying the spread of disease lack of transportation facilities, and the low ability to in the Puskesmas area, it can be used to determine the pay for transportation costs. The district expects those focal point of service related to the type and amount Puskesmas health workers to provide medical services of drugs and the types of health equipment [Baker and at home or in places close to where they live. There- Reinke 1994]. fore, the community tends to call health workers at Health equipment and health support facilities home, considering the same costs if they have to go (laboratories) in the Puskesmas are inadequate. Lack to the Puskesmas and is facilitated with a cell phone. of health equipment and health support facilities (lab- This situation shows the high ineffectiveness of time oratories) in Puskesmas often disappoints people who spent by nurses and midwives in carrying out their du- have to travel long and arduous trips. This situation ties at the health centre [Budiarto et al. 2007]. further strengthened the interest of the community The number of health workers available at the not to go to the Puskesmas. The availability of medi- Puskesmas have not been able to complete all man- cal devices, consumables, and medicine needs to be datory health efforts carried out at the Puskesmas, increased according to the needs of each Puskesmas. especially services outside the building. This is due Communication and transportation tools must be met to the area of the Puskesmas and the difficulty in to make public health centres affordable to the com- reaching the target. Therefore, the number of health munity. Therefore it is necessary to offer medical de- service activities was reduced by the number of visits. vices and consumables that support health services, As a result, the coverage of services outside the build- especially for cases of the disease that often occurs in ing was lower. health centres. Many emergency cases require special Meeting the health workers’ needs in the Puskes- equipment and skills, but in reality, they are still lack- mas in remote and border areas needs to consider ing. Since the Puskesmas and its network are the first the situation and condition of the local Puskesmas. targets for handling emergency cases, the provision In some Puskesmas, some officers were incompe- of emergency equipment needs to be available in all tent with their responsibilities. For example, drug Puskesmas systems. It is necessary to provide skills services, health promotion, and eradication of infec- to the health workers [Ristrini et al. 2004, Handayani tious diseases was carried out by workers who only et al. 2006]. graduated from junior high or high school. Planning for staff needs at the Puskesmas should be carried out CASE OF NUSA TENGGARA TIMUR PROVINCE with a macro-level analysis of the long-term effects of various training strategies and employee recruitment. The Province of Nusa Tenggara Timur (referred to as Furthermore, microanalysis of the profile of health NTT) is of interest. This region consists of 21 regen- workforce activities was also carried out. The macro cies/cities, with a population of 4,256,200 inhabit- analysis will determine the number of personnel to ants. The number of poor people is around 66.54% plan, while microanalysis will determine the type of of the total population in NTT Province. It is one of health workers who should be recruited. The deploy- the areas that is not getting much attention. The more ment of personnel began with assessing local service east, the more uneven development is so that devel- needs after going through functional analysis [Budi- opment inequality is felt to impact social disparities. arto et al. 2005]. Poverty is assessed by several factors, namely: (1) Drug acquisition is generally not under the request. education; (2) human resources; (3) income per Many health worker complaints about the discrepancy capita and (4) access to health services [Triwahyuni between the type and amount of drugs with cases of 2010]. In fulfilling the basic rights of the community, the disease being treated are things that need attention. one of the most important is access to health ser vices. In fulfilling drug needs, it should be adjusted to the The limited access and the low quality of health

82 acta_oeconomia.sggw.pl Kennedy, P.S.J. (2020). Health policy problems in Indonesia’s border region. Acta Sci. Pol. Oeconomia 19 (4), 79–85, DOI: 10.22630/ ASPE.2020.19.4.43

services will have implications for: (1) low endur- average until the age of 66. In 2016 the life expect- ance to work for a living; (2) limited ability of chil- ancy rate was 66.04, which means that children born dren from families to grow and develop, and (3) low in 2016 are expected to live on average until the age of levels of maternal health1. 67 years, and in 2017 the life expectancy rate is 66.07. The HDI value for NTT Province ranks third lowest The life expectancy of the population every year is nationally after Papua and West Papua. The NTT HDI increasing but not too significantly, only around growth is lower than the national rate in 2017, which 1–5 months2. amounted to 0.91% [RPJMN NTT 2018]. The HDI For cases of infant mortality, children under five and of NTT Province for the period 2013–2017 experi- toddlers in NTT show fluctuating numbers. The highest enced an average increase of 1.86%. The NTT HDI number of infant deaths occurred in 2016, as many as continues to increase, namely from 2016 it amounted 1,689, the highest number of deaths of children under from 67.75 to 68.28 in 2017 or increased by 0.36 in five were 449 in 2016, and the highest number of infant three years. Based on the national average from 2005 deaths was 1,174 in 2017. The highest number of infant to 2012, NTT is in the 31st position of 34 provinces. deaths occurred in Kupang District in 2015 as many as Although NTT HDI continues to increase nationally, 198. The highest number of child deaths under five it is still far behind. In 2012, HDI of NTT Province is years of age occurred in 2015 in South Central Timor 60.81, which lagged far back from the national (In- District and the highest number of under-five deaths in donesia) average HDI, which reached 67.70. Then the South. While maternal deaths cases in the province it continued to lag until 2017 when the HDT NTT have decreased from year to year, in 2013, the number was 63.73, and the national average HDI had reached of maternal deaths was 176 cases, declining in 2014 by 70.81 [RPJMN NTT 2018]. 158 cases, for 2016 and 2017 respectively it was 182 Low HDI is mainly due to the per capita expendi- and 163 cases3. ture indicator, which is only 7.12 million and is the From another health dimension, malnutrition is lowest per capita expenditure in Indonesia. The aver- a condition in which a person is declared malnour- age ranking of education in NTT is the fourth-lowest in ished, or in other words, his nutritional status is be- Indonesia, and life expectancy is also the sixth lowest low average standards. Nutrition in question can be compared to other provinces. The poverty rate shows in the form of protein, carbohydrates, and calories. In as the third poorest province in Indonesia with a sparse Indonesia, the case of Protein Energy Deficiency is population, reaching 22.01% of the people, far higher one of the leading nutritional problems that are often than the national of 10.7% [Bappenas 2017]. found in toddlers [Ariesthi 2018]. The percentage of Life expectancy is used to assess health status. Be- children under five years of age in the province of sides, it is one indicator that is taken into account in NTT declined from 2015 to 2017 but is still the high- evaluating the HDI. The description of NTT residents est in Indonesia. The increase occurred in the percent- in 2015 has a life expectancy of 65.96, which means age of children under five and under five years old that children born in 2015 are expected to live on wasting and underweight4.

1 Kementerian Perencanaan Pembangunan Nasional [Ministry of National Development Planning of the Indonesian Re- public] website, https://www.bappenas.go.id/files/5613/5229/8326/bab28__20090202204616__1756__29.pdf [accessed: 26.08.2019]. 2 Badan Pusat Statistik Nusa Tenggara Timur – BPS NTT [East Nusa Tenggara Central Statistics Agency] website, https:// ntt.bps.go.id/pressrelease/2018/05/07/699/indeks-pembangunan-manusia-2017-mencapai-63-73.html and https://ntt.bps. go.id/pressrelease/2017/04/20/635/ipm-nusa-tenggara-timur-tahun-2016.html [accessed: 26.08.2019]. 3 Sistem Informasi Pembangunan Daerah Provinsi Nusa Tenggara Timur – SIPD NTT [East Nusa Tenggara Regional Devel- opment Information] in Rencana Pembangunan Jangka Menengah Daerahprovinsi Nusa Tenggara Timur – RPJMD NTT (2018). Nusa Tenggara Timur Province Medium Term Development Plan for period 2018–2023, Kupang. 4 Kementerian Kesehatan [Minister of the Health of the Indonesian Republic] website, https://pusdatin.kemkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/PROFIL_KESEHATAN_2018_1.pdf [accessed: 26.08.2019].

acta_oeconomia.sggw.pl 83 Kennedy, P.S.J. (2020). Health policy problems in Indonesia’s border region. Acta Sci. Pol. Oeconomia 19 (4), 79–85, DOI: 10.22630/ ASPE.2020.19.4.43

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PROBLEMY POLITYKI ZDROWOTNEJ W REGIONIE GRANICZNYM INDONEZJI

STRESZCZENIE

Artykuá ma na celu zbadanie problemów polityki zdrowotnej na obszarach przygranicznych Indonezji. Ba- danie w sposób szczególny koncentruje siĊ na problemach zdrowotnych w prowincji Nusa Tenggara Timur. Zastosowano metody opisowo-iloĞciowe. W wyniku analizy stwierdzono, Īe konieczne jest dalsze intensywe rozwijanie infrastruktury ochrony zdrowia na obszarach przygranicznych. NiezbĊdne są takĪe uspoáecznienie oraz usprawnienie usáug ubezpieczenia zdrowotnego Ğwiadczonych przez rząd, a takĪe poprawa zasobów ludzkich w sektorze zdrowia.

Słowa kluczowe: polityka zdrowotna, problemy zdrowotne, obszar przygraniczny, Nusa Tenggara Timur

acta_oeconomia.sggw.pl 85

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Formatio Circumiectus – Ksztaátowanie ĝrodowiska Wydawnictwo Uniwersytetu Rolniczego w Krakowie al. 29 Listopada 46, 31-425 Kraków, tel. 12 662 51 57, 12 662 51 59

1644 0757